ASN's Mission

ASN leads the fight to prevent, treat, and cure kidney diseases throughout the world by educating health professionals and scientists, advancing research and innovation, communicating new knowledge, and advocating for the highest quality care for patients.

learn more

Contact ASN

1401 H St, NW, Ste 900, Washington, DC 20005

email@asn-online.org

202-640-4660

The Latest on Twitter

Kidney Week

Abstract: TH-PO462

Sex Disparities in Cardiovascular Events in Incident Dialysis Patients

Session Information

Category: Hypertension and CVD

  • 1401 Hypertension and CVD: Epidemiology, Risk Factors, and Prevention

Authors

  • Shah, Silvi, University of Cincinnati, Cincinnati, Ohio, United States
  • Christianson, Annette, Cincinnati VA, Cincinnati, Ohio, United States
  • Meganathan, Karthikeyan, University of Cincinnati, Cincinnati, Ohio, United States
  • Leonard, Anthony C., University of Cincinnati, Cincinnati, Ohio, United States
  • Thakar, Charuhas V., University of Cincinnati, Cincinnati, Ohio, United States
Background

Cardiovascular events remains the leading cause of mortality in patients with end stage renal disease (ESRD) and the risk of cardiovascular events is 10 to 20 times higher in ESRD as compared to general population. Sex disparities in the major cardiovascular events in dialysis patients have not been studied.

Methods

We evaluated 96,729 patients who initiated dialysis between 1/1/2007 and 12/31/2008 from the United States Renal Data System with linked claims for Medicare Part A and Part B or Medicare Primary Other as the primary payer for the entire one year post dialysis initiation. Using ICD-9 codes, we identified hospitalizations for major adverse cardiovascular events (MACE), defined by unstable angina, acute myocardial infarction (MI), congestive heart failure (CHF) , and stroke. Using case mix adjusted logistic regression models, we examined the impact of sex on MACE as the primary outcome.

Results

The mean age was 70±12 years. In the study cohort, 45.2% were women and 61.4% were white patients. All cause one-year mortality was 43.3%. Overall, women had higher frequency of MACE as compared to men (41.8% vs. 38.3%, p value<0.0001). Additionally, women had higher incidence of acute hospitalizations with CHF (36.7% vs. 33.1%, p value<0.0001), and stroke (5.8% vs. 4.5%, p value < 0.001) as compared to men. The frequency of unstable angina (7.3% vs. 7.5%, p value = 0.20) and acute MI (2.6% vs. 2.5%, p value = 0.26) was comparable between women and men. In the adjusted analyses, women had higher odds of MACE as compared to men (OR, 1.16; 95% CI, 1.13-1.19). As compared to men, women also had higher adjusted odds of CHF (OR, 1.17; 95% CI, 1.14-1.21) and stroke (OR, 1.28; 95% CI, 1.20-1.35). Odds of acute MI (OR, 1.08; 95% CI, 1.00-1.18) and angina (OR, 0.99; 95% CI, 0.94-1.04) did not differ significantly between men and women.

Conclusion

Women are 16% more likely to have acute hospitalizations with MACE as compared to men in the first year after incident ESRD. Additionally, women experience 17% higher rates of hospitalization with CHF and 28% higher rates of hospitalization with stroke. Further studies are needed to better delineate the factors associated with this sex disparity in the risk of MACE, and its treatment approaches.